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NCCN Flash Updates: NCCN Guidelines Updated for Kidney Cancer

NCCN has published updates to the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines^®), the NCCN Drugs & Biologics Compendium (NCCN Compendium^®), the NCCN Radiation Therapy Compendium™, and the NCCN Imaging Appropriate Use Criteria (NCCN Imaging AUC™) for Kidney Cancer. These NCCN Guidelines^® are currently available as Version 1.2024.

Link directly to the Updates section of the NCCN Guidelines: Kidney Cancer

Terminologies in all NCCN Guidelines are being actively modified to advance the goals of equity, inclusion, and representation.

KID-1

• Initial workup
  • Stage I (T1b)
    • Option added: Ablative techniques (in select patients)
• Footnote removed: If metastatic disease is present or the patient cannot tolerate ureteroscopy.

KID-A

• Title revised: General Principles of Management for Renal Cell Carcinoma Surgery
  • Bullet 6 revised: Thermal ablation (eg, cryosurgery, radiofrequency ablation, microwave ablation) is an option for the management of patients with clinical stage T1 renal lesions.
  • Bullet 6, sub-bullet removed: Thermal ablation is an option for masses <3 cm, but may also be an option for larger masses in select patients. Ablation in masses >3 cm is associated with higher rates of local recurrence/persistence and complications.
  • Bullet 6, sub-bullet 1 added: Thermal ablation is an option for clinical T1b masses in select patients not eligible for surgery.
  • Bullet 6, sub-bullet 2 revised: Biopsy of lesions is recommended to be done prior to or at time of ablation. Biopsy of small lesions confirms a diagnosis of malignancy for surveillance, cryosurgery, and radiofrequency ablation strategies.
  • Bullet 7 added: SBRT is considered an ablative therapy and may be considered for medically inoperable patients (not optimal surgical candidates) with stage I (category 2B), II, or III (both category 3) kidney cancer.
  • Bullet 8, sub-bullet 1 revised: Small renal masses <32 cm given the high rates of benign tumors and low metastatic potential of these masses.
  • Bullet 10 added: Patients either with large-volume distant metastases or tumors with large sarcomatoid burdens should receive systemic therapy prior to cytoreductive nephrectomy

KID-B (1 of 5)

• Follow-up
  • Header revised: Stage 1 (T1a)
    • Follow-up During Active Surveillance
      • Bullet 3, sub-bullet revised: Abdominal CT or MRI with and without IV contrast if no contraindication within 6 months of surveillance initiation, then CT, MRI, or ultrasound (US) at least annually
    • Follow-up After Ablative Techniques
      • Bullet 3, sub-bullet 1 revised: Abdominal CT, or MRI with and without IV contrast (unless otherwise contraindicated), or contrast-enhanced US at 1–3 months, 6 months, and 12 months after ablation, then annually thereafter. at 1–6 mo following ablative therapy, then CT or MRI (preferred) annually for 5 y or longer as clinically indicated. If patient is unable to receive IV contrast, MRI or contrast-enhanced US are is the preferred imaging modalitiesy
      • Bullet 3, sub-bullet 2 revised: If there is imaging or clinical concerns for residual or recurrent disease recurrence, then more frequent imaging, renal mass biopsy, or further treatment may be indicated
• Footnote c revised: CT is with IV contrast and MRI is with or without contrast. Imaging with contrast when clinically indicated. (Also for KID-B 2 and 4)

KID-B (3 of 5)

• Footnote c added: CT is with IV contrast and MRI is without or with contrast.

KID-C (3 of 3)

• Systemic Therapy for Non-Clear Cell Histology
  • Preferred regimens
    • Sunitinib was moved to Other Recommended Regimens.

HERED-RCC-1

• Criteria for Further Genetic Risk Evaluation for Hereditary RCC Syndromes
  • Criteria 4, bullet 2 revised: Any first-degree relative who meets the criteria in boxes 2 and or 3 who is unable or unwilling to genetically test
• Footnotes
  • Footnote c added: Using age as a sole criterion for genetic risk evaluation is generally not a sensitive method.

HERED-RCC-2

• Hereditary RCC Syndromes Overview
  • Column 2, row 2 revised: Type 1 Papillary
  • Column 2, row 3 revised: Chromophobe, hybrid oncocytic tumors, clear cell, oncocytomas, angiomyolipomas, papillary RCC
  • Column 2, row 4 revised: Angiomyolipoma (and other PEComas), renal cysts, eosinophilic solid and cystic RCC, RCC with fibromyomatous stroma, eosinophilic vacuolated tumor, low-grade oncocytic tumor, clear cell
  • Column 2, row 5 revised: HLRCC associated RCC or FH-deficient associated RCC/type 2 papillary
  • Column 2, row 6 revised: Clear cell, chromophobe
  • Column 2, row 7 revised: SDH deficient RCC Clear cell (not usually SDHB), chromophobe, papillary type 2, renal oncocytoma, oncocytic neoplasm

GENE-1

• Column 1 revised: Individuals with syndrome features (HERED-RCC-2)/or criteria in HERED-RCC-1 met

HERED-RCC-A

• Table 2: Features of Von Hippel-Lindau (VHL) Disease
  • Major Features
    • Bullet 3 revised: Pheochromocytoma (PCCs)

HERED-RCC-B (2 of 2)

• Reference 9 added: Binderup MLM, Smerdel M, Borgwadt L, et al. von Hippel-Lindau disease: Updated guideline for diagnosis and surveillance. Eur J Med Genet 2022;65:104538.

 

 

For the complete updated versions of the NCCN Guidelines, NCCN Guidelines with NCCN Evidence Blocks™, the NCCN Drugs & Biologics Compendium (NCCN Compendium^®), the NCCN Biomarkers Compendium^®, the NCCN Chemotherapy Order Templates (NCCN Templates^®), the NCCN Radiation Therapy Compendium™, and the NCCN Imaging Appropriate Use Criteria (NCCN Imaging AUC™), please visit NCCN.org.

To view the NCCN Guidelines for Patients^®, please visit NCCN.org/patientguidelines.

Free NCCN Guidelines apps for iPhone, iPad, and Android devices are now available! Visit NCCN.org/apps.

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